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General NPI Number Information
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NPI Number | 1538418561
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Entity Type | Organization
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Legal Business Name | DEVINE HEALTHCARE LLC
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 956 MOLLOY DR
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City | O FALLON
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State | MO
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Zip | 63366-3229
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Country | US
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Telephone | 314-496-1858
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Fax |
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Provider Business Mailing Address
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Address Line | 956 MOLLOY DR
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City | O FALLON
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State | MO
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Zip | 63366-3229
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Country | US
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Telephone | 314-496-1858
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Fax |
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Authorized Official
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Title or Position | ADULT NURSE PRACTITIONER, OWNER
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Name | MRS. TECONDA L. DOUGLAS
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Credential | ANP-BC
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Telephone | 314-496-1858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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